Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-6305

Title:

AN ACT CONCERNING IMPLEMENTATION OF THE SUSTINET PLAN.

Vote Date:

3/7/2011

Vote Action:

JFS to INS

PH Date:

2/14/2011

File No.:

341

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

To provide legislation for the implementation of the SustiNet Plan developed as a result of the 2009 SustiNet Bill.

Substitute Language:

1. Requires that the primary care doctor serving on the SustiNet Board is a private practice doctor.

2. Amends the provision concerning how DSS implements SustiNet reforms to establish that it will be done contractually.

3. Amends the definition of “small employer” to the existing definition in state law – because SustiNet G will be offered to all employers at the time the Exchange begins selling plans, it is not necessary to mirror the “small employer” definition in the exchange. Any employer can purchase a SustiNet G policy in 2014, not just those employers who can purchase on the exchange.

4. Requires that the Authority may not offer SustiNet G until it conducts a feasibility study and risk assessment which determines that offering coverage is financially viable and does not require General Fund dollars.

5. Removes the provision that provided an exemption to the definition of lobbying for donations by a 501(c)(3).

6. Removes language regarding provider liability.

RESPONSE FROM ADMINISTRATION/AGENCY:

Christopher G. Donovan, Speaker of the House: The bill reflects the recommendations of the SustiNet Board of Directors and the 200 plus volunteers who applied their expertise on various committees and task forces pursuant to PA 09-148.

SustiNet builds on the strength of healthcare pooling to increase purchasing power, lower costs and expand access to everyone. It will maximize the potential of federal reform, spend state healthcare dollars more efficiently, improve quality and offer employees and families a new health insurance choice. According to Dr. Jonathan Gruber, of the MIT Department of Economics, these measures will save Connecticut taxpayers between $226 and $277 million annually, beginning in 2014. If SustiNet's system and payment reforms succeed in slowing cost growth even 1% per year, the state budget will improve by $355 million in 2014, with gains reaching more than $500 million a year starting in 2019.

Senator Donald E. Williams, Jr., President Pro Tempore: SustiNet's vision to assure affordable health care coverage for all Connecticut residents while implementing health care delivery reforms that will slow the growth in costs; making that vision a reality is not a luxury, but a necessity.

We must not focus only on long term benefits, but on the current fiscal climate and budgetary restraints. I believe the details of the SustiNet estimated savings of $226 to $277 million per year in 2014 are crucial. These savings will enable implementation of the many reforms in the plan and additional savings after that.

We must focus on job creation and business development in our state, both of which may depend on our ability to lower healthcare costs. Given that our business taxes are the 5th lowest in the country, we are appropriately turning our attention to our high healthcare costs. SustiNet offers a promising frame for tackling one of our most costly and intractable problems.

Permanent Commission on the Status of Women: We request that any plan that is developed address women's special needs and concerns to ensure that we have equal access to health care, ensuring that it is:

● Gender appropriate

● Culturally competent

● Comprehensive and preventive

● Confidential

Consumers must be able to access an array of practitioners, including midwives and nurse-practitioners.

Secretary Benjamin Barnes, Office of Policy and Management: I have concerns the potential impact of this bill on implementation of federal health care reform provisions in Connecticut. I also offer cautions with respect to the executive branch's authority and ability to carry out essential governing responsibilities, including managing the state budget.

Our primary focus must be to ensure that the state's health insurance exchange is viable and functions optimally to provide adequate and affordable health insurance coverage for all Connecticut residents. Unfortunately, HB 6305 could have serious, but perhaps unforeseen and unintended, impacts on how the exchange will be able to succeed by impacting the insurance marketplace. The bill appears to exempt SustiNet from licensure by the Department of Insurance (lines 490 and 501) and indicates that SustiNet intends to participate in and outside of the state's health insurance exchange. The federal Patient Protection and Affordable Care Act (PPACA) prohibits the state health insurance exchange from offering plans that are not qualified health plans – that must be licensed by the state.

We believe that the definition of small employers must be made by the exchange, not SustiNet, and be based on careful market analysis and a detailed understanding of the functioning of the exchange.

Another concern for the administration is that some of the bill's provisions severely weaken the executive branch's authority and ability to manage major components of the state budget. For example, the bill provides broad authority over state employee benefits in Section 6(b) and (c). This provision negates the administration's existing and rightful authority to negotiate benefits and rules with our employees through SEABAC and effectively establishes SustiNet as the employer, not the administration, in collective bargaining.

In addition, Section 7 creates a new coverage group with unknown fiscal impact and Section 12 requires that if state health expenditures come in under projections, the difference would be deposited to the SustiNet separate non-lapsing account for disbursement at SustiNet's discretion. These provisions could have a significant and dramatic impact on the state budget based on decisions made by a quasi-public agency, not the state itself, and would effectively tie the hands of the elected and accountable executive and legislative branches with regard to fiscal decision making.

The bill also provides broad authority to SustiNet over Medicaid, which not only pre-empts the administration's existing authority, but also is contrary to federal law. It appears to be inconsistent with the federal requirements for DSS as the single state Medicaid agency.

Victoria Veltri, Acting Healthcare Advocate & General Counsel, Office of the Healthcare Advocate (OHA): The bill reflects the concerns the SustiNet Board raised with respect to moving at a pace suited to both federal healthcare reform and our state's budget issues. That is why the preliminary steps of SustiNet include the concepts of costs-savings and increased efficiencies in our existing state programs, and not asking for substantial investments in initial funding from the General Assembly. Adopting strategies such as: patient centered medical homes; interoperable electronic health records; evidence based medicine; and payment reforms will save taxpayers money. These are no-cost measures that will reduce costs and improve quality of care for SustiNet Populations. The SustiNet Plan in addition to achieving these efficiencies will be empowered to use its pooling power to reduce administrative savings.

The Medicaid expansions under SustiNet are consistent with federal healthcare reform and will provide Connecticut with matching rates up to 95%. The use of the basic health plan mechanism will provide Connecticut with maximum federal resources to insure individuals up to 200% of the federal poverty level who are ineligible for Medicaid.

Raja Staggers, Executive Director, Connecticut Commission on Health Equity: Connecticut has great need for health services among vulnerable populations who lack health insurance, experience limited access to care, and who require a medical care system prepared for a culturally, ethnically, and linguistically diverse population. There is documented evidence that certain sub-populations in Connecticut have poorer health outcomes than the population at large. These groups experience reduced access to culturally competent and coordinated services, often resulting in lower quality care and delayed medical treatment. Racial, ethnic, and linguistic minorities are particularly vulnerable, as are other groups that experience social and economic disadvantages.

In proposing a high quality health care system and increased access to healthcare through the extension of health insurance coverage to Connecticut residents who would otherwise go uninsured; and promoting culturally competent and integrated care models through SustiNet will not only improve the quality of care for diverse populations, but may reduce costs, leading to a long lasting competitive advantage over other health insurance strategies.

Kevin Lembo, State Comptroller: The number of uninsured in Connecticut has steadily increased year after year and if the trends continue, the state could see the level of uninsured reach almost 400,000. Lack of coverage prevents people from getting the care that they need and ultimately increases uncompensated hospital costs when they get sick.

SustiNet will give Connecticut the opportunity to provide healthcare to the uninsured, and to achieve better health outcomes. The recommendations are designed to make the plan a high-quality option of coverage that is attractive in the marketplace.

Additionally, SustiNet will position the state to harness newly available federal dollars.

Frank Sykes, Legislative Analyst, African-American Affairs Commission (AAAC): Roughly 17.3 % of the uninsured are African-American. As a group African-Americans experience the highest rates of cancer, diabetes, hypertension, HIV infection and obesity.

The urgency for health care access is even greater now than ever before in view of overall higher unemployment rates for all races. African-American unemployment rates in 2010 were almost twice the state average.

NATURE AND SOURCES OF SUPPORT:

Barbara Edinberg, Director of Research, Bridgeport Child Advocacy Coalition (BCAC):

SustiNet will provide Connecticut residents with affordable and better health care coverage; and will provide Connecticut with millions of dollars in cost-savings as well as new revenues.

The rising cost of health care is contributing to the deficit problem. Connecticut is spending $8 billion each year and still, hundreds of thousands of residents are uninsured and thousands of small businesses are struggling to meet payroll because of rising health care costs.

Cheryl Dunson, President, Connecticut League of Women Voters: The League believes that every Connecticut resident should have access to a basic level of care at an affordable cost that promotes health and prevents disease. In addition, health care services should be equitable, efficient and economical. Better health care means an improved quality of life

The League strongly recommends and endorses SustiNet's emphasis on preventive care and the implementation of primary care case management, patient-centered medical homes, and use of health information technology.

Finally, the League supports the creation of the SustiNet Plan Authority to implement the SustiNet Plan as well as establishment of the SustiNet Plan Consumer Advisory Board. These bodies will provide the necessary oversight and accountability required to ensure state residents receive high-quality, well-researched health care that is effective, efficient, safe, timely, and patient-centered.

Brenda Shipley: I support this bill with the exception of section 13 pertaining to limiting provider liability for patient injury.

A Connecticut surgeon under the influence of drugs caused me serious harm. The surgeon's hospital administrators and his colleagues knew about his drug addiction, but I did not. He was allowed to operate on me unsupervised. Seven years later, after two corrective surgery's, I continue to suffer chronic pain. The surgeon has since died of a heroin overdose.

Section 13 language doesn't make sense and does not seem fair. This language has no place in this bill.

Carolyn J. Malon, DDS: Dental Health is an important part of overall health. It is encouraging to see that the proponents of SustiNet understand the importance of dental care, and have included dental benefits as a component of the plan. I urge you to maintain the language which pertains to dental benefits when implementing the SustiNet G Plan.

Alicia Woodsby, Public Policy Director, National Alliance on Mental Health (NAMI): NAMI-CT supports the efforts to expand access to health care coverage through the SustiNet Plan with the exception of the language in Sec. 7. The language in Section 7 lines 592-597 must be revised to clarify that the intention of the bill is that all individuals with incomes between 133% and 200% of the FPL, not just parents currently enrolled in HUSKY A, will be in the Basic Health Plan.

NAMI-CT strongly recommends the following revision to Sec. 7:

Individuals enrolled in the basic health program shall include parents all adults with incomes above one hundred thirty-three percent of the federal poverty level, as determined by the Affordable Care Act, and at or below two hundred percent of the federal poverty level, including but not limited to parents who would otherwise qualify for HUSKY Plan, Part A, and individuals described in section 17b-257b.

While NAMI-CT welcomes the state's focus on healthcare reform, we continue to ask that state policymakers be ever mindful of the fact that any proposed reform should include:

● Support for maintaining or expanding current state of healthcare mandates for individuals with mental illnesses, including protection of CT mental health parity statutes and ongoing monitoring of the private insurance industry regarding implementation of state and federal parity laws

● Strengthening of CT's Medicaid coverage in order to maximize federal reimbursement and expand coverage to many of our most vulnerable citizens.

Steve Huleatt, Connecticut Association of Directors of Health (CADH): We urge you to consider changes in the bill that support a role for public health as a key partner in statewide health reform. Specifically: Section 3(b), sets forth the composition of the SustiNet Authority Board of Directors (the “Board”), it should be amended to include representation from local and state government public health officials. Public health promotes health programs and policies that support good health; prevents disease outbreaks and conditions that give rise to poor health; and protects people from health threats. As such, public health is critical to ensuring cost containment in statewide health reform.

Section 11(a) should also state that the SustiNet plan will be administered to promote quality and cost-saving public health initiatives and population based health services and should recognize the critical role that local health departments already play in providing community based preventative care services.

Dr. Jerry Hardison, Optometrist, Connecticut Association of Optometrists: To improve the quality and safety of care we recommended:

● The formation of standing committees representing all provider groups that review, establish and promote evidence based clinical guidelines. These guidelines will become the basis for quality measures to evaluate clinical care. These measures will become the basis for payment reform.

● The formation of patient centered medical homes that fully embrace the skills, resources and mandated services of all participating providers will ensure patient access to all sources of care based on their needs and particular desires.

● Allowing providers coordinated access to practice management opportunities in order to develop more efficient practices, provide high quality targeted patient educational resources and through health information exchange have real time access to patient history and data.

If not fiscally possible, consider applying reform to our current public assistance programs.

Ellen Andrews, PhD, Executive Director, Connecticut Health Policy Project: SustiNet incorporates input from all corners of Connecticut's health care landscape including consumers, businesses, and government. Most important, it addresses the needs of Connecticut's 418,000 uninsured residents struggling to access care in an increasingly hostile and fragmented system. Passage of SustiNet will give consumers protections and options left out of the Affordable Care Act and puts taxpayers in a better position to take advantage of federal opportunities.

I am particularly enthusiastic about the provisions to support Patient-Centered Medical Homes (PCMHs) and critical primary care capacity. PCMHs provide consumers a champion to help them navigate a fragmented health care system. PCMHs support primary care providers, allowing them to practice medicine the way they were taught.

In addition, SustiNet emphasizes prevention, quality and patient safety, payment reforms to move from our current volume-based system to one that pays for value.

Eric Brown, Connecticut Council of Police Unions AFSCME, Council 15: HB 6305 presents public employers and public employees with opportunities to secure quality health care at competitive rates, thereby driving down costs associated with public employment.

Evelyn A. Barnum, J.D., Chief Executive Officer, The Community Health Center Association Of Connecticut (CHCACT): Section 11 of the bill addresses most of the attributes of the primary care/preventive model Federally Qualified Health Centers (FQHCs) have been using for many years.

At a time when congress and the President are increasing the emphasis on FQHCs as a cost effective health care delivery system and when the emphasis on medical homes is increasing, Connecticut will be best served by pursuing SustiNet and strengthening the statewide system of care that health centers offer Connecticut's children and families.

The FQHC model aligns with the SustiNet goals to slow the growth of health care costs, improve the quality of health care services and improve patients' health outcomes

James Sterling, CEO, Stirling Benefits, Inc.: SustiNet reflects what is possible within the existing union agreements; it builds on the work of other states and will reduce the cost of HUSKY and MEDICAID. SustiNet pays for health, not healthcare.

I've not met a single business person who is against reducing costs. And if leveraging state purchasing power conveys to municipalities, businesses and individuals a new and improved health plan option, most say: “what's wrong with that?” Even insurance agents generally agree that more options are good for their clients.

SustiNet can be defended by the numbers alone. A vote for SustiNet is to improve the way we do business at the state level. We'll all benefit from that.

Maggie Adair, Deputy Director, Connecticut Association for Human Services (CAHS):

SustiNet offers a high-quality health insurance plan that promotes health competition in the marketplace through new choices, and a new level of accountability and transparency. It invests heavily in evidence-based prevention strategies to keep people healthy, lower costs, and promote sustainability of the health care system. SustiNet addresses the uninsured and the underinsured. It addresses inefficiencies, employs best practices that tackle care coordination and communication, and ultimately keep us healthier and saves us all money.

A cornerstone of SustiNet is the creation of a large pool to create a critical mass of people, thus creating leverage and lowering cost.

Mary Jane Williams, PhD., RN, Connecticut Nurses Association: Nurses want to make sure the following questions are addressed in the legislation:

● Is it truly an inclusive system?

● Does it improve people's access to health care?

● Does it reallocate resources and infrastructure to support primary care and prevention?

● Does it rely on evidence-based care and reward quality?

● Does it tackle disparities in health care quality and outcomes?

● Is it affordable for working families?

● Does it offer affordable and predictable costs to businesses and employers?

● Does it demand accountability, transparency and equity from the private health care market?

● Does it invest in nursing?

● Does it open the door for RNs to optimize their skills, knowledge and abilities in all roles and settings to help patients?

● Does it facilitate the development of partnerships between practitioners' to optimize the delivery of care?

● Does it provide a coherent health care vision and strategy?

● Is it cost effective and affordable for the individual and for the state?

● How will this affect the patients of registered nurses?

Rev. Joshua Mason Pawelek, President, Greater Hartford Interfaith Coalition for Equity and Justice: As a member of the Steering Committee of Connecticut's Interfaith Fellowship for Universal Healthcare, I am testifying for the more than 700 clergy across the Connecticut who have been working to transform our health care system so that all residents have access to quality, affordable health care. We are united by a common moral conviction that health care is a human right and that government bears some responsibility for ensuring that right.

We won't achieve our health care vision if we don't address racial disparities. We commend the SustiNet Board for the attention it has paid to this pernicious and perplexing dynamic.

Sheldon Toubman, New Haven Legal Assistance Association, INC.: First, I wish to express support for the effort to move to universal health care and the inclusion of a public option.

Second, the SustiNet Board of Directors recognized that, for low-income individuals, a move into the health insurance exchange would not be satisfactory, because, among other things, the cost sharing would be too high – even with federal subsidies.

Third, it is critical that the protections in Section 7 be included in the final legislation: “Medical assistance provided through the basic health plan shall include all benefits, limits on cost-sharing and other consumer safeguards that apply to medical assistance provided in accordance with Title XIX of the Social Security Act.”

Stan Dorn, Urban Institute: SustiNet has three main elements. First, SustiNet applies the best thinking regarding health care delivery and provider payment to slow cost growth and improving quality of care. A new quasi-public Authority will make these changes with existing state-sponsored populations, including Medicaid, HUSKY, and state employee coverage.

Second, SustiNet's coverage of HUSKY adults will expand in 2014 to include all low-income, uninsured adults, who earn no more than 200 % of the federal poverty level. The federal government will provide funding through Medicaid and the Basic Health Program option in the Affordable Care Act.

Third, SustiNet's health coverage will be available to employers and individuals throughout the state. In 2014 when the state's health insurance exchange is operational any individual or employer will have the option to buy SustiNet.

SustiNet promises to reduce costs in three ways:

1. Implement the Affordable Care Acts expansion of Medicaid eligibility, which results in federal Medicaid dollars substituting for the more than $100 million in annual General Fund spending on health care for low-income residents.

2. Implement the Basic Health Program option, the state saves $50 million a year by shifting some of the underlying funding from Medicaid to the Basic Health Program, for which the federal government will pay all costs. Additional savings would come from making that shift for lawfully present immigrants who now receive State medical Assistance for Noncitizens.

3. If SustiNet's delivery system and payment reforms prove effective, the state will save on Medicaid, HUSKY, and coverage for state employees and retires. A 1% reduction in annual health care cost increases would yield General Fund savings of $78 million in 2014 and higher amounts in later years.

Jonathan M. Weber, MA, PA-C, Government Affairs Chair, Connecticut Academy of Physician Assistants (ConnAPA): ConnAPA believes the Connecticut health care system requires coordinated and systematic reform in order to meet the needs of the population, to ensure quality, and to control costs. We applaud the efforts of the Connecticut legislature toward this goal through the SustiNet plan.

ConnAPA does not advocate for any specific structure of health care reform and financing. However ConnAPA does advocate setting forth the following principles:

● Access to quality, affordable, cost efficient health care for all patients

● Use of evidence based medical care

● Equitable distribution of care and resources

● Portable and sustainable payment mechanisms for individuals & families

We are committed to working with the legislature and all involved parties to plan and implement a fair and comprehensive reform of Connecticut's health care system. In this commitment, ConnAPA supports:

● Health care delivered by qualified providers in physician-directed teams

● Optimal utilization of primary care in a reformed health system

● Emphasis on heath promotion and disease prevention in health care reform

● Reform that enhances the relationship between the patient and the clinician

Dr. Keith vom Eigen, American College of Physicians: The American college of Physicians believe HB 6305 could serve as the system that will increase access to care, improve quality of care, and be affordable provided it is primary-care based.

First there must be enough primary care doctors participating in the system, open and willing to see this expanded population of patients. This will require adequate reimbursement for the “patient centered medical home” model to work. Specialist physicians must be available and willing to see these patients when the need arises.

Doctors must be able to practice without fear of frivolous lawsuits. The current language of the bill includes some narrow liability protections. We feel this should be expanded to a level closer to the provisions in the initial SustiNet bill which covered physicians following established guidelines in treating patients. These two issues are the most important in helping to maintain and increase the physician workforce, for both primary care physicians and specialists.

In addition, physician involvement in the SustiNet Board of Directors and other committees is critical. As currently stated in Section 3 (b), only one doctor is mandated. This is inadequate. The Board must consist of a significant percentage of different physician perspectives, both primary care and specialists.

Dr. Richard Duenas, Connecticut Chiropractic Association (CCA): CCA proposes that the bill contain a provision to establish a formal Advisory Committee comprised of all healing arts practitioners as defined in Chapter 369 along with practitioner representatives from respective colleges. This will improve the inter-professional relations and collaboration of Connecticut's Healing Arts Practitioners

John Erlingheuser, Connecticut Advocacy Director, American Association of Retired Persons ( AARP): One of the key strengths of the proposal is that it provides another option for coverage for many groups starting in 2014.

Concerns for AARP:

● The lack of prohibition in rate variations based on individual characteristics such as age, gender, or health status. Such prohibitions were included in the 2009 SustiNet legislation. Without protections against age rating, older adults will pay several times more than a younger person simply because of their age.

● Composition of the board of directions. We propose that in addition to SustiNet Plan members, “consumer advocates” be added on the board. Another voice that is needed is an advocate for Medicaid patients.

● Patient safety and quality is critically important to any health care reform proposal and we respectfully ask the committee to reconsider the decision to eliminate the patient safety committee.

● The broad waiver of liability contained in Section 13. AARP supports the incorporation of evidence-based medicine, objective comparative analysis of the effectiveness of various treatment alternatives, and clinical care guidelines as a potential means to reduce medical errors and improve quality of care. However, we are not comfortable with the elimination of all provider liability for avoidable injury to patients contained in 13. There is also the inequity of creating a two-tier liability scheme: one for individuals in SustiNet and another for everyone else.

Jonathan B. Knapp, DMD: Lines 825-834, “SustiNet G” which must include “comprehensive, commercial-style benefits, including vision, dental…with an emphasis on prevention that includes encouraging individual responsibility for controllable health risks…” I urge you to support efforts to discourage behaviors, such as consumption of sugar-sweetened beverages and junk foods, which have significant negative impacts on oral health.

Lines 1370-1375, “…dental care coverage that shall be comparable in scope to the median coverage provided by larger employers in the Northeast states.” I urge you to support such efforts to make appropriate dental coverage available to more families given the growing evidence of the strong connections between oral health and overall health.

Connecticut Conference of Municipalities (CCM): CCM urges the committee to maintain the local options established throughout the proposal as a critical means to provide towns and cities choices in addressing skyrocketing health care costs.

Linda Ross, Christian Science Committee on Publication for Connecticut: The Christian Science Committee on Publication for Connecticut requests that the following amendment be included:

Add a new subsection (c) (15) to section 11 (page 39) of the bill that reads:

(c) In furtherance of the objectives set forth in subsections (a) of this section, the SustiNet Plan Authority shall… (15) Ensure that quality measurement for nonmedical and alternative service is as stringent as that used for medical services but also consistent with the patients desire to utilize a nonmedical form of treatment and is based on nationally-recognized standards and measures, if available.

Nonmedical services include religious nonmedical care provided by Christian Science practitioners and Christian Science nurses.

Ray Rossomando, Legislative Coordinator, Connecticut Education Association (CEA):

CEA believes that the savings to school districts will help spur investment in resources that will make our schools even more successful; and that the long-term potential for reduced costs throughout the system will help return investment into the community.

We urge the committee to include language ensuring that among the SustiNet Plan Authority coverage options are plans that do not trigger the federal tax.

Section 3, establishes a 15-member SustiNet Plan Authority Board that includes one representative from organized labor. We believe that due to the numerous public and private industries, services, and economic sectors represented by organized labor, there should be a second member specifically representing non-state employees.

Sections 14 and 16, address participation in the SustiNet plan for non-state employers. We are concerned about a provision that could constrain savings by hindering participation.

We respectfully ask the committee to consider making non-state public employer participation in the state employee plan a mandatory subject of bargaining from day one.

Terry Edelstein, President/CEO, Community Providers Association: We call attention to specific provisions related to our roles as nonprofit providers, consumers of services and providers of healthcare services for individuals with disabilities.

Section 11( c) (1) encourages the use of “patient-centered medical care.” We support the provision of such services that seek to integrate physical and behavioral health services.

Section 11 (e) (1) requires the Authority to “provide advice on health information technology,” with the goal of encouraging SustiNet providers “to use interoperable electronic health records.” We need your special assistance here. There are limited federal incentives to provide incentives for primary care, hospitals and physicians practices, but very narrowly-drawn incentives and no technical assistance provisions for clinic providers. We are working with our delegation and our national association to provide EHR incentives for behavioral health, but this legislation is far from assured. We need your assistance at the state level to provide incentive for mental health, addiction treatment and other disability providers to implement HIT systems.

We encourage you to assure that SustiNet provide rates to cover the cost for services provided at all levels of care so we can meet the needs of this complex and diverse population.

Lynn Rapsilber, CT APRN Society: All major primary care providers should be named to the Board of Directors, bringing to the table different perspectives with added knowledge of barriers to access, That would include a CT licensed primary care APRN who practices in CT. APRNs currently practice in all settings including their own private practice.

Likewise, in line 857 you need to attract primary care APRNs as well as physicians if you are going to serve the populations you hope to serve

Colleen M. Murphy, Executive Director and General Counsel, Freedom of Information Commission (FOI): The FOI Commission is concerned that the exemptions to disclosure set forth in Section 3 (q) may be unnecessarily broad (lines 245-257). It is unclear why it is necessary to protect provider negotiations and compensation arrangements.

Item (4) exempts information obtained through “confidentiality agreements” entered into pursuant to the provisions of section 10 of the bill. The scope and breadth of such confidentiality needs to be better defined.

Contract provisions cannot supersede the FOI Act – only federal law and state statute can.

The FOI Commission urges further review of these provisions as they relate to transparency of this monumental government program.

Jean Rexford, Executive Director, Connecticut Center for Patient Safety: I am hoping as the bill moves forward that it will include stronger provisions relating to patient safety benchmarks and requirements.

Section 13 limits liability if a SustiNet physician is using a standard of care that is recommended by a committee made up of clinicians. I think that needs to be broadened and include scientists, researchers and public members and public health representatives.

Transparency and accountability will Connecticut's patient population as safe as possible when receiving health care.

Susan Manganello, Nurse: Support Amendments that would require more patient safety precautions. As a nurse working to provide healthcare, I am discouraged that there is little improvement in transparency and accountability in how SustiNet would be deliver care. Patient safety needs to be the beginning point. The patient needs to be the reason of healthcare. Patient safety and patient centeredness seems to be forgotten again.

Gretchen Vivier, National Association of Social Workers (NASW): Implementing SustiNet would be beneficial to the people and organizations social workers serve as well as to the social workers.

NASW applauds efforts to track and reduce racial and ethnic disparities, “All SustiNet Plan members shall be provided with member identification cards that have an identical design.”

Many social workers are self-employed or work for nonprofit organizations. Allowing them and their organizations to buy into this pool would open new options to them.

American Cancer Society: In the absence of a system that ensures adequate, affordable coverage, a cancer diagnosis can quickly translate to bankruptcy for families and in the worse case scenarios, the inability to access potentially lifesaving treatments. As such, we must ensure that healthcare reforms in Connecticut meaningfully meet the needs of all individuals diagnosed with cancer.

SustiNet ensures timely access to the full range of evidence-based health care services, including prevention and primary care necessary to maintain health, avoid disease, overcome acute illness, and live with chronic illness.

The plan contains a minimum standards package that preserves consumer health care benefits including mental health, vision and dental coverage. SustiNet also provides for coverage of smoking cessation services. The Cancer Society would like to work with the legislature and proponents of the bill to include Medicaid coverage of FDA approved tobacco use cessation services. SustiNet would require no premiums or deductibles for preventative care. We urge inclusion of all preventative cancer screenings.

William J. Cibes, Jr.: The primary focus of SustiNet is bending the cost curve of health care down. Extrapolating from 2005 data, state governments now spend a third of their budget on health care, and if present trends continue, within a decade the health sector alone will devour half of state spending.

The Affordable Care Act encourages and anticipates that states will experiment with different models of health care cost control. Connecticut should seize the opportunity by adopting SustiNet, the primary aim of which is to put in place a model which replaces the bankrupt “fee-for-service” payment system with incentives to improve quality and make care more cost-effective, to encourage health care providers to focus on preventive care, to identify chronic conditions and remove their root causes, and to provide continuing and coordinated care for chronic illnesses that do exist.

Once the SustiNet pool captures a significant share of the market, it can effectively reshape the overall system. When SustiNet's model demonstrates the power to restrain health-care inflation, employers would also join in order to save money, both for themselves and for their employees.

Regina Walsh, L.Ac., President, Connecticut Society of Acupuncture and Oriental Medicine (CSAOM): We are encouraged by the emphasis placed on use of evolving research and experience to develop health care delivery reforms which provide care that is known to be safe, improve health, and prevent unnecessary spending.

Karen Schuessler, Director, Citizens for Economic Opportunity (CEO): The passage of Phase I of SustiNet in 2009 has laid the groundwork for Connecticut to utilize federal resources to address our health care problems. By implementing the public option, competition will be injected into the system which will provide lower costs and better outcomes.

Tom Swan, Executive Director, Connecticut Citizen Action Group (CCAG): SustiNet is a financially sound way for Connecticut to implement national reform and to design our health system in a way that emphasizes health.

CCAG strongly endorses the plan because it will put Connecticut in the lead on implementing national reform and save taxpayers, consumers, employers and state millions of dollars while improving health care system.

Pat Checko, Chairman, MATCH Coalition: It is important to see two of the Tobacco and Cessation Task Force's recommendations addressed in the plan:

● Require all public and private health insurers to provide comprehensive tobacco usage cessation interventions, including counseling and all FDA-approved nicotine replacement therapies and pharmaceuticals.

● Provide a more integrated approach to the prevention and control of disease which acknowledges that modifying behavioral and environmental factors are critical to a total wellness model.

Frances Padilla, Vice President, Universal Health Care Foundation of Connecticut:

SustiNet does not propose to offer the state employee plan to all of Connecticut. State employees and retirees stay in one pool, joined by municipalities. Medicaid and HUSKY members stay in a second pool. Small business, nonprofits, individuals and municipalities after 2012 go into the third pool called the “public option”

Enrollees will receive care under through primary care medical homes with an emphasis on prevention; electronic health records, evidence-based practice and payment reform. Combined with an infusion of new federal dollars, these reforms will slow the rate of spending on health care, saving the state between $226 million and $277 million starting g in 2014.

Regarding responsible open governance, the bill calls for establishment of a quasi-public agency with a board composed of all the expertise needed to carry out SustiNet effectively.

Kelson Ettienne-Modeste, MD, Small Business for a Healthy Connecticut (SBHC):

I created a business so I could support my family, with the intention of securing better healthcare coverage. I'm unable to expand my business because the cost of healthcare for individuals and small business owners is too costly. There seems to be too few checks and balances in our current health insurance market. Despite the expense of coverage, there is no assurance of the quality or quantity of services provided.

Implementing SustiNet and making it available to small business owners will revive the small business community and give it the confidence to make bold long-term commitments hiring and reinvesting.

Dr. Estela Lopez: In light of the state budget situation and the fact that health insurance subsidies under the federal Affordable Care Act do not become available until 2014, this bill calls for a phase-in of the implementation from 2011 to 2014, and beyond.

Dr. David Katz, President, CT State Medical Society (CSMS): First, we strongly support the inclusion of language to (1) establish liability protections and safe harbor for physicians participating in SustiNet program who meet established practice standards and guidelines and (2) the development and establishment of quality initiatives. We are confident that these will generate tremendous cost savings by reducing the cost of defensive medicine within the program. Further, we believe that the focus on quality and quality metrics will allow the state to look more closely at what is working and what isn't. However the quality guidelines must be designed developed and maintained by physicians and other health care professionals providing the services.

CSMS believes the proposed program structure separating products such as the HUSKY, Charter Oak and the State Employees Health Benefit Program makes sense. However, it is imperative that reimbursements within the HUSKY products do not become the ceiling for services provided to patients through the SustiNet program. In addition, the difficulties of the current managed care products in HUSKY program in attracting physicians leads to our support of language to move from a managed care system to one administered by an Administrative Service Organization (ASO). This coupled with the increased focus on Primary Care Medical Home Models, will eliminate some of the administrative hassles that have caused physicians to decide against participation in the program. If the ASO sticks to the claims process and claims management, physicians will be allowed to make medical necessary decisions that are in the best interests of their patients.

CSMS has the following concerns with the proposed language:

1. Specific reimbursement and health plan structure are not discussed in the bill language. CSMS stands ready to assist in the design of a compensation plan that appropriately recognizes the physician work, medical expense and liability costs involved in providing highquality medical care.

2. There is no language that adequately or sufficiently addresses physician workforce issues.

3. Representation on the SustiNet board must include primary care physicians, as well as other physicians equally impacted by these reforms.

Lindsay Farrell, Organizing Director, Connecticut Working Families: Working and middle class families see worse health outcomes and are less able to afford our current system. The SustiNet plan is an excellent way to both improve the quality of care for families in Connecticut, and make the system more affordable for workers and employers.

Mary Moninger-Elia, Connecticut Staff for the Alliance for Retired Americans: Retirees have experience advocating for health care reform. Affordable, accessible, quality health care is crucial to pass on to the next generation. SustiNet is an opportunity to do that.

Paul J. Rapanault, Director, Uniformed Professional Fire Fighters Association of Connecticut: It is essential that this and future generations be given the fullest opportunity to obtain health care that is universal, continuous, affordable, sustainable, and enhances health and well-being by promoting access to high-quality health care that is effective, efficient, safe, timely, patient-centered and equitable.

Rev. Bonita Grubbs, Executive Director, Christian Community Action; and Member – SustiNet Board of Directors: As someone who works with people who are challenged economically and use HUSKY, I see this Bill as an opportunity to increase access to doctors and health care, whether it is medical, behavioral or oral.

We live in difficult economic times and the State has a projected $3.5 billion deficit so clearly, in the days ahead, you must pay attention to the costs related to implementing this plan, while protecting and promoting the health of Connecticut's citizens and increasing access.

Neal Lippman, MD, President, Connecticut Chapter American College of Cardiology (CCACC): We have seen our patients denied access to specialists and even primary care physicians in the past under Charter Oak. The reimbursement to doctors and other healthcare providers was extremely low and subsequently patients could not find a doctor who accepts it. We cannot afford to make a similar mistake with SustiNet.

Dr. Frederick Moffa, Granby Family Eyecare, LLC: Dr. Moffa gave testimony of a patient from Massachusetts and a patient from Connecticut with similar health issues, who both lost their jobs. The patient from Massachusetts would continue with her medical treatments because she could retain her insurance due to MA healthcare law. The patient from Connecticut would be forced to put her health in jeopardy because she would lose her employer provided health insurance. Where you live should not dictate the cost or type of coverage you get, and SustiNet will provide the health insurance reform to solve this issue.

Each year health insurance for teachers and municipal employees increase 10-15%, which impacts local budgets. These insurance cost increases directly influence property taxes, allowing municipal employees to join the pool will help for stabilize this cost factor.

Dr. Bruce Gould, Internist and Primary Care Physician: I practice medicine at a community healthcare facility in the north end of Hartford that cares for some of the most vulnerable and underserved populations in the state. SustiNet will offer a well coordinated health plan that provides coverage to a diverse population in Connecticut. Using a patient centered medical home model, SustiNet will help patients manage their own care, and clinicians in coordinating the complexity of the care while focusing on prevention and chronic disease management, thus achieving better outcomes both medically and financially.

Domenique Thornton, General Counsel & Director of Public Policy, Mental Health Association of Connecticut, Inc (MHAC): Connecticut state government spends about $ 8 billion annually on health care coverage for state employees, retirees, Medicaid recipients and other populations. With Federal health care reform, Connecticut taxpayers will save by replacing current state spending on HUSKY and Medicaid with newly-available federal dollars. This proposal will make Connecticut eligible for a 90% match in federal dollars under the Affordable Health Care Act.

Jane McNichol, Executive Director, Legal Assistance Resource Center of Connecticut, Inc: As we move toward universal health care, it is vitally important that we ensure that the coverage is coupled with access to affordable, quality health care.

Sections 7 and 8 contain a mandate for a Basic Health Plan that is designed to ensure programs for low-income residents with incomes between 133% and 200% of the federal poverty level who otherwise would not be able to afford health care. This is an important piece of protection for parents and caregivers of children covered by HUSKY A

In 2014, Connecticut will have the option of continuing this parental coverage under Medicaid, but there is a significant financial incentive to end Medicaid coverage at 133% of the federal poverty level.

Lori Pelletier, Secretary-Treasurer, Connecticut AFL-CIO: Healthcare is financially crippled due to the lack of non profit insurers in the system to keep for-profits insurers honest. Benefits have diminished and workers have lost ground as employers seek to maximize their profits at the expense of family healthcare.

The SustiNet Board of Directors produced clear and concise recommendations for slowing the growth of public and private health care costs, expanding access to affordable, high quality, comprehensive coverage for the residents of Connecticut.

Dr. Julie R. Rosenbaum, Internist & Primary Care Physician: Provided testimony about a patient that through the loss of his job lost health insurance and was unable to pay for his medications. Ultimately, he was hospitalized for a week at the cost of $15,000 which could have been avoided all together. In my practice, there are hundreds of stories just like this one. I would like to see a world where electronic medical records are used and there is a system in place that would ensure that no patient falls through the crack; a world where doctors don't get paid by how many patients they see or how many procedures they do, but rather how well patients are kept healthy. What is described is a functioning patient-centered medical home. Early evidence shows that coordinated care decreases hospitalization, improve patient satisfaction, and improve the quality of care while decreasing costs.

Clarke King, President, AFSCME local 1716: The bill will allow for municipal employees to get into the same health insurance pool as current state employees and create one large pool which would allow people to get the best price for health insurance coverage. This bill will save towns, the state, non profits and small businesses tens of millions of dollars per year.

Stacey Munro, Connecticut Naturopathic Physicians Association (CNPA): SustiNet's goal of increasing the number of citizens who have access to healthcare is a good goal, and one that we strongly support. Naturopathic Physician's play a role in helping patients stay healthy.

The exchange that will begin in 2014 will provide consumers with a multitude of choices on health plans. We urge you to ensure that Naturopathy is covered under the plan.

Jennifer Jaff, Executive Director, Advocacy for Patients with Chronic Illness, Inc. The Patient Protection and Affordable Care Act (PPACA) does not do enough in the area of cost especially the cost of insurance. Connecticut can finish the job by passing SustiNet; and thereby, become a national leader in health care cost containment.

Chronic illness accounts for 75% of every health care dollar spent in the United States. Without addressing the cost of chronic illness, we cannot control health care costs.

Patients who participate in their own care are more compliant with doctor's orders and, therefore achieve better health outcomes. Thus, designing ways to encourage patients to participate in their own care will help to control health care costs

Rev. Abraham Hernandez, Interfaith Fellowship for Universal Health Care: The Interfaith Fellowship supports this bill because it makes health care more affordable, expands access to care to the poorest of the uninsured, and requires tracking of and developing strategies for addressing racial and ethnic health disparities.

Lori Franklin, Bridgewater Board of Finance and small business owner: Last year Bridgewater spent over $220,000 to insure its 10 full time employees. This year's cost is over $230,000. This represents ten percent of Bridgewater's operating budget. Our town is not required to provide health insurance for its non-union workers, but we do because it is important to our employees and their families. The ability to buy into the large group plan like SustiNet would help Bridgewater continue to provide this important benefit.

My husband and I each own and operate our own small businesses and every year, we watch our premiums rise by 15 to 20 % over the previous year. In 2007, our yearly premium for a moderately comprehensive family plan reached $16,000. Since then, we have been able to get our yearly premiums down to about $12,000, by having a combination of all or parts of our family on an HSA (Health Savings Account) high deductible plan.

A large, non-profit group plan like SustiNet would not only help our family manage our costs, but SustiNet would benefit from the premiums that a younger, healthier family like mine would pay into it.

Patricia Baker, President & CEO, Connecticut Health Foundation: Between 2009 and 2010 the Connecticut Health Foundation invested a total of $380,000 to support the SustiNet Board's project management team. With the help of both state and national experts and dedicated volunteers, the SustiNet Board crafted a guide to transform Connecticut's health care system.

In our research and experience, the foundation believes the following reforms will create a better health care delivery system:

A culturally- and linguistically-competent, patient-centered medical home

Bundled payments and value-based purchasing to include the eventual development of accountable care organizations or ACOs Community-based, preventive care services with strong linkages to communities and neighborhoods

Measurable health indicators and objectives to monitor the racial and ethnic health disparities over time

Strong health information and data exchanges

Evidence-based care

Benefits that specifically address mental health parity and oral health

Including those most affected to participate in the decision-making process

SustiNet's design supports a basic concept that greater numbers will provide a greater opportunity for impact. If state employees and retirees and Medicaid recipients are added, more than 600,000 lives are covered.

Ron Cretaro, Executive Director, Connecticut Association of Nonprofits (CT Nonprofits): The SustiNet Board's final report recommends ways the state can control health care costs, save money and spend taxpayer's health care dollars more wisely. Improving our healthcare system to ensure coverage and lower costs is an economic imperative. Nonprofit employers have been facing years of rising healthcare costs that are becoming more difficult to sustain. This puts them at a severe disadvantage and leads to lower wages and fewer jobs. HB 6305 calls for the SustiNet Plan to be offered to nonprofits at the earliest feasible date on or after January 1, 2012, which is a welcomed option.

Joanne Clark, owner, Clip Joint, in Willimantic: As a self-employed small business owner, I have concerns about the future of our health care system. One illness or injury could wipe me out financially. Connecticut is losing small businesses to exorbitant health care costs.

SustiNet will allow small businesses to prosper and grow by providing a larger pool to slow the growth of health care costs. This plan will give choices, affordable premiums, and most importantly I won't be drowning in medical debt and lose everything I worked so hard for.

As rate increases of 20-47% are approved by the Connecticut Insurance Department, more and more people will not be able to afford health care and the state will be forced to pick up the bill for anyone who becomes hospitalized and cannot pay their expenses.

The current health care delivery system needs to change if Connecticut residents and businesses are to be responsible for their own health care needs.

Sal Luciano, Executive Director, Council 4, AFSCME: Health care insurance has gone up 100% in 8 years. Connecticut spends almost 7 billion dollars a year on Medicaid, Medicare, State and County worker coverage. Under SustiNet: providers would get more money to keep infections down; would be required to provide free care if you get an infection; decrease emergency room visits; coordinate medical information electronically; keep costs lower by making sure people get the care they need; practice evidence based medicine, including BEST practices; keep costs lower by preventing chronic diseases.

Paul Lavellee, President, AFSCME Local 2663: One of the most fundamental services provided by the State is medical assistance. No citizen should be denied necessary healthcare. As a state employee, I am grateful to have an affordable healthcare program. It is regrettable that every Connecticut citizen is not as fortunate. The SustiNet plan has the power to make healthcare affordable and accessible for more residents.

The following individuals provided personal stories of support for the SustiNet Plan:

● Christine M. Joyner, BA MS RN

● Laura Rae, Willimantic

● Stacy Kate Sparks, Centerbrook

● Peggy J. Webbe, Tolland

● Elsa Peterson Buchowski, Norwalk

● Jody Wynn Rodiger, Manchester

● Richard Mackowiak, Eastford

Ganimedes Barrera, Stamford

Brenda Cerezo, Small Business for a Healthy Connecticut

NATURE AND SOURCES OF OPPOSITION:

Susan Israel, MD: HB 6305 is built on assumptions that may not be realistic. It is unlikely that Connecticut can afford the level of care proposed, and that privacy can be maintained while moving electronic health records all over the internet to employees of all the companies involved in their use. If this morass of laws is implemented as conceived, we will be substituting another set of problems for the current ones.

To say that all this will work financially, based on Jon Gruber's economics, is a stretch, given that he represents one end of the spectrum. To base far reaching state legislation on what its supporters would like to hear, is questionable judgment. It is hard to believe that Connecticut could have enough money to give such total care as proposed. The administrative costs of all the agencies involved, the cost of the medical homes providing 24/7 care, preventive care programs, and electronic health records would be enormous.

We do not want to see the dream of universal health care turn into a nightmare that this legislation may bring.

America's Health Insurance Plans (AHIP): The SustiNet model, as reflected in this bill, rejects the successful approaches of the past and turns to the public option that has been rejected at the federal level. AHIP cannot support a public option.

We believe that a public option is not necessary and that the SustiNet approach to bringing more populations into the state's self-insured program will create serious budget risks, both to start up and administer such coverage programs and in bearing the full risk of the newer covered populations. It will also threaten jobs of Connecticut citizens currently employed in the health insurance industry. The savings projected for SustiNet, other than those that come from federal ACA funds that would come to Connecticut without SustiNet, could only be achieved through tighter control of provider reimbursements as are now seen in Medicaid. That approach will increase the cost shift to those employers and individuals still purchasing private coverage and exacerbate the ongoing challenge of the state to develop adequate networks for its programs.

We urge you to take advantage of the expertise already available from our industry and fashion a market based solution more consistent with federal reform, one that reflects Connecticut's long history of forging solutions that work in the real world, stand the test of time and serve as a model for all of the other states.

Andy Markowski, Connecticut State Director, National Federation of Independent Businesses (NFIB): Passage of this bill would do nothing to reduce cost of health insurance for many small businesses. It harms existing small business, and will discourage entrepreneurship and relocation of new business to the state.

Implementing the SustiNet plan, which is heavily dependent on federal subsidies, is most certainly inappropriate. Lawmakers should keep in mind the following points when considering health care reform:

● Business owners are best equipped to make the decision about when, what type, and how much health insurance they can afford to provide.

● In today's competitive employment market, voluntarily providing robust benefits is a key way small businesses attract and keep good employees.

● Lawmakers should focus on providing incentives to business owners to provide health insurance.

Although NFIB is supportive of common-sense initiatives to bend the curve on health insurance costs, small business will continue to oppose government-run health care or systems that impose new mandates.

Connecticut Association of Health Plans: The main distracting and disturbing fact about the SustiNet bill is: the SustiNet proposal before you contains provisions for what has come to be known as a “public option”. The Connecticut Association of Health Plans cannot support a bill containing a public option. The concept is particularly problematic for Connecticut, given our budget situation, the vital importance of the health insurance industry to our state economy and our state's history of underfunding provider reimbursement.

a) SustiNet carries major budget risk. It calls for the state to become the bearer of health insurance risk for municipal governments, private employers and individuals.

b) SustiNet is not consistent with rebuilding Connecticut's economy and jobs. It sends precisely the wrong message to health insurers located in Connecticut: We don't want you and we don't need you.

c) SustiNet exacerbates Cost shifting. It moves large portions of the population which is currently the defacto funder of public programs in Connecticut (privately insured citizens) into those very same public programs, and, therefore, squeezes out private employer and individual coverage. The math of an actuarial death spiral is pretty simple – fewer citizens insured by the private sector, more citizens insured by the state exacerbates the cost shift, making private insurance more expensive, leading more citizens to seek health insurance from the state.

d) SustiNet decreases provider access: As the number of citizens on public programs grows the number of providers able to accept public reimbursements decreases.

e) The public option is not consistent with federal reform: By focusing on the public option, the SustiNet bill misses one of the essential tenets of federal reform: a robust private marketplace with appropriate rules of engagement by all participants is the approach chosen by Congress and the President.

David A. Whitehead, President and Chief Executive Officer, William W. Backus Hospital: We believe that there is a better approach to coordinating healthcare reform while improving access to care, addressing provider financial losses, reducing the state deficit, and mitigating the cost shift to businesses.

SustiNet will essentially create an insurance plan for those individuals with family incomes between 133% and 200% of the federal poverty level who are currently covered by Medicaid. Moving these individuals to the Basic Health Plan enables the state to shift the full cost of covering these individuals to the federal government. This results in additional state dollars being available to help balance the state budget. Although this plan clearly benefits the state, it does not address current issues faced by beneficiaries and providers.

Connecticut hospitals have worked together to propose a solution to modernize Medicaid:

● Raise Medicaid physician rates to Medicare levels and allow hospitals to bill for physician services provided.

● Implement existing Medicaid law and apply medical management to all Medicaid populations. Estimated savings include $60 million from medical management and $60 million in administrative savings. Savings to the state budget: $60 million annually.

● After using $60 million in savings to help the state budget, reinvest the remaining $60 million of savings, plus $35 million from current Disproportionate Share Hospital payments, to begin to modernize the hospital payment system by raising physician rates and beginning the transition to a Diagnosis Related Group (DRG) system. Cost to state budget: $0.

● Introduce a gain-sharing element that encourages effective, co-coordinated patient care management. Cost to state budget: $0.

● Align the state's Medicaid program with health reform guidelines by enrolling in private insurance those Medicaid patients with incomes eligible for federal subsidies in the new Health Insurance Exchange. Savings to the state budget: $229 million annually.

● Create an up-to-date Medicaid hospital payment system that better focuses on quality. A DRG system, such as that used by Medicare, creates the foundation for a system that can also reliably measure quality, efficiency, and safety. Replacing Connecticut's outdated TEFRA target system (which does not connect payment to specific care provided) with a DRG system would provide a manageable, appropriate way to relate the resources need by specific patients with the payments hospitals receive for caring for those patients. Cost to the state budget: $0.

Griffin Hospital, Middlesex Hospital, Saint Francis Hospital and Medical Center, Yale New Haven Health System, DAY KIMBALL HEALTHCARE (DKH) , HARTFORD HEALTHCARE: Submitted testimony similar to that submitted by David A. Whitehead of William W. Backus Hospital

Stephen Frayne, Senior Vice President, Connecticut Hospital Association (CHA):

The vision for SustiNet and its Plans is expansive, bold and ambitious. But boldness and ambition are not enough – to be successful, a vision has to be matched with ability and sufficient resources. The proposal does not provide sufficient resources.

He goes on to outline the CHA's position as was outlined in Backus hospitals testimony.

Steve Gentile: I urge the rejection of HB 6305 and the shifting of people to taxpayer funded healthcare plans.

Julie Chubet: While the SustiNet program has worthwhile goals, but does little to address or to lower medical treatment expenses. The proposal raises important, but unanswered questions on how a public medical insurance plan can create affordable coverage.

Actuarial studies have shown that creating a larger medical plan by simply combining groups does not result in lower costs. Also the idea of self insuring does nothing to lower medical treatment costs.

Lower medical insurance premiums can only be created by getting individuals more involved in their medical treatment or by limiting coverage.

Lynn Ward, President & CEO, Waterbury Regional Chamber: We need to create jobs, not create more government that will be a detriment to the healthcare industry.

SustiNet jeopardizes the good paying private sector jobs and creates another level of government which will undoubtedly have significant upfront costs.

Connecticut is already one of the most business unfriendly and expensive states in the country to conduct business. We cannot afford to create another level of bureaucracy that will threaten jobs and increase Connecticut's already alarming unfunded liabilities higher.

Robin Wilson, President & CEO, Quinnipiac Chamber of Commerce: HB 6305 will only serve to exacerbate health insurance costs and concerns. What is not known is how much the plan would cost, particularly if the plan includes benefit levels that are on par with state employees.

Implementing the SustiNet Plan, which is heavily dependent on federal subsidies, is inappropriate at this time.

We are concerned about the impact of the SustiNet plan on our economy. The private-sector insurance market in Connecticut provides thousands of well-paying jobs to Connecticut residents, which has a positive multiplier effect on our economy as well as state and revenue bases. SustiNet will be in direct competition with the private sector and in many ways, have an advantage on the private sector because many of the costs of the program, such as marketing, will be borne by taxpayers.

Rich Carella, Legislative Committee, Middlesex Chamber of Commerce: Testimony is essentially the same as the Quinnipiac Chamber of Commerce.

Metro Hartford Alliance: Any legislation that is irrelevant to the vital work that is being done to balance the state budget should be postponed until the state is on sound financial ground.

Questions regarding the fiscal impact of the bill remain unanswered, and Connecticut simply cannot afford to increase its debt exposure. Our focus should be on meeting the state's existing financial obligations, including a $200 million shortfall in the state's Medicaid account.

SustiNet does not address the high cost of state mandates that drive up the cost of health insurance especially for small business. Its proposal to create a quasi-government authority is not aligned with the Governor's directive to streamline government. And most importantly, its inexperience of managing health plans will undoubtedly increase the budget deficit and impact the existing, high-paying, health insurance jobs that are linked to our economy.

Eric George, Connecticut Business & Industry Association (CBIA): Opposes to the SustiNet bill for the following reasons:

● To succeed, it must do so at the expense of private industry.

● It would be an unfunded liability.

● State would have to pay medical claims for everyone in the plan. This is very risky.

Connecticut Trial Lawyers Association: Section 13: would put patients who receive care through the SustiNet plan at a distinct disadvantage, as the doors of the courts would be closed to them, even if they were seriously harmed by a health care provider, because the harm caused was in compliance with clinical care guidelines.

Phil Boyle: I am opposed to the SustiNet bill based on the following reasons:

1. It will cost private sector jobs

2. It will add additional taxes to the state and federal tax rolls

3. Based on the example of the Connector in Massachusetts, the SustiNet plan will add additional costs to health insurance premiums for private sector companies in order to subsidize the SustiNet enrollees

4. I am baffled to why the state of Connecticut thinks it can jump into the insurance business and think they can do a better job than private sector companies that have volume, experience, and history

5. The federal government has already set up a plan for health insurance, why does the state of Connecticut need to duplicate efforts thus adding to our state expenses and deficit.

Mr. John Torello, Cheshire: He presented the personal story of his sons and the family's experience with the medical care that was provided. As a result he is against the language in section 13: a health care provider who provides health care services to a SustiNet plan member shall not be liable for any injury to a plan member that occurs during the provision of a service by such provider.

This language appears to be a shield for SustiNet providers against litigation, which may be the only protection for victims of negligence or malpractice like my family. It appears that SustiNet members are being subjected to a different set of rules than the rest of the people in the state.

Mary Jane Burke, Owner, BGR Radiator: My understanding of SustiNet is that companies with less than 50 employees would be pooled and be limited to making medical insurance purchases through a pool. What I know is that you will completely cut off my ability to work with an agent who knows and understands me and my employees. One size does not fit all and putting us all in the same box will not work for the small business community. Why shouldn't we have the same choices as the larger companies in CT? Competition provides for a better product, in insurance as with any business product.

Do not take the passage of this program lightly; understand the implications of price on families and businesses. Our state is reeling under a mountain of debt and we should be looking to consolidate a bloated state government, not add another state agency. Please don't penalize the small businesses of CT and make it impossible for us to work with a trusted agent who has our back in so many ways.

Susan C. Winkler, Executive Director, CT Insurance and Financial Services Cluster: Over 17,000 workers are directly employed by our health insurers and many more work in our allied health industry. This bill has the potential to increase the budget deficit and impact the existing, high paying, health insurance jobs that are linked to the Connecticut economy.

The Bill is ill-timed, because many of the components of the SustiNet proposal are already mandated by federal reform legislation. It is important to continue with the reform work currently taking place and the opportunities that are available to improve the health care system in Connecticut.

Questions regarding the fiscal impact of the bill remain unanswered. Efforts to create a self-insured plan for current state programs and subsequently additional populations, puts the State at significant potential financial risk.

SustiNet does not address the high cost of state mandates that drive up the cost of health insurance especially for small businesses; and its proposal to create a quasi-government authority is not aligned with the Governor's directive to streamline government.

Anthem Blue Cross and Blue Shield: Anthem agrees that the bill outlines worthwhile goals to work towards and offers the following comments in furtherance of these principles:

● Exploring and implementing new ideas while capitalizing on the innovative and successful programs of the current system will help ensure continuity of access to quality care, benefit program design and administration, and health care financing and risk management.

● Building on the resources and expertise of the private sector health insurance industry will help safeguard the financial stability and solvency of the program which is essential to ensuring that the goals achieved by this bill are sustainable in the long run.

The private health insurance industry has demonstrated experience in delivering innovative and efficient programs consistent with the goals outlined in this bill. To reach the goals outlined in the, we will need to combine the significant reach of our state government with the efficiency, innovation and dedicated and talented resources of the private market.

Reported by: Randall Graff

Date: March 9, 2011

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