As someone who has spent decades inside Connecticut’s health care marketplace, I know our system needs fixing.
Employers, families and clinicians are all telling us the same thing. But Senate Bill 3 does not tackle the core drivers of health care inflation, and it does not build a transparent, accountable pathway to sustainable affordability.
Instead, SB 3 creates a new trust fund, a new set of programs and a new set of promises without fixing the fiscal and structural problems already visible in Connecticut’s existing public coverage approach.
That is not reform. It is a costly gamble dressed up as affordability. Hope is not a strategy.
SB 3 starts by creating the Connecticut Affordable Health Care Trust Fund, then goes out of its way to say the money in that fund is not state property, not a state obligation and not subject to the normal rules taxpayers would expect for a major public initiative.
The state Treasurer is authorized to invest the money, hire consultants, enter contracts and manage the fund, while the bill explicitly says any obligation of the fund is not an obligation of the state. That should concern anyone who believes major health policy changes should come with real budget discipline and direct public accountability.
The bill also transfers $200 million from the Federal Cuts Response Fund into this new structure. That is a remarkable choice. A fund intended to help Connecticut respond to federal disruption is being redirected to finance a new coverage initiative whose costs, risks and long-term obligations have not yet been fully defined.
From there, SB 3 instructs the Office of Policy and Management to design and implement the Connecticut Option using money from the new trust fund and any other state, federal or other funding sources it can secure. It sets politically appealing premium targets, including coverage costing no more than 2% of household income for certain lower-income residents and no more than 8.5% for some higher-income households.
But the bill never directly answers the most important question in health policy: if the premium people pay is below the real cost of coverage, who pays the difference?
That is not a theoretical concern. Connecticut’s own experience with the Partnership Plan should serve as a warning.
A KNG Health study found that the existing Partnership Plan 2.0 spent more on benefits than it collected in premiums, with benefit spending exceeding premiums by 3.5%, and projected that expanding a similar public option model could reduce state tax and assessment revenue by between $44.5 million and $1.13 billion over 10 years.
The same study found that replacing lost revenue and keeping such a program financially stable could require between $134.5 million and $17.3 billion in additional funding over the 2026 to 2035 period if provider payments are not reduced.
And if the state tries to avoid that taxpayer burden by squeezing providers instead, the consequences are serious. The KNG study estimated that total spending would need to fall by 15% to put the plan on secure financial footing, and that one way to achieve that would be to reduce provider reimbursements by about 19%.
In a state already struggling with health care affordability and access, that is not a path to stability. It is a recipe for narrower networks, greater provider strain and fewer choices for patients.
Supporters of SB 3 call this affordability. But affordability cannot mean shifting costs off the front end only to move them onto taxpayers, employers, hospitals and physicians later. It also cannot mean expanding bureaucracy while ignoring real delivery-system reform.
The current bill layers a Connecticut Option and a possible Basic Health Program on top of the existing Medicaid, ACA marketplace and subsidized coverage structure. It creates working groups, reporting mandates and administrative machinery, but it does not require the kind of aggressive move toward value-based care that could begin to address the actual drivers of cost growth.
As employer groups have argued, this is more likely to redistribute costs than reduce them.
Connecticut should pursue a different strategy: more transparency, stronger competition and payment models that reward value instead of volume. The state should focus on policies that lower underlying costs, not on building a new quasi-public financing structure that depends on one-time transfers, undefined subsidies and optimistic assumptions.
Senate Bill 3 may be well-intentioned, but good intentions do not balance budgets or guarantee access to care. Connecticut cannot afford to create another underfunded public health coverage experiment that leaves taxpayers and employers exposed, pressures providers and postpones the hard work of real reform.
Jeffrey Hogan is the president of Farmington-based Upside Health Advisors, a healthcare consultancy focused on advising payers, providers, employers and health systems on value-based care, policy and market strategy.
