Juan A. Figueroa, President, Universal Health Care Foundation of Connecticut | Expanding affordable health coverage

SustiNet builds a new plan from health coverage already funded by Connecticut taxpayers, according to your executive summary. Does this mean SustiNet comes at no additional cost?

SustiNet is Latin for the word “sustains,” and is drawn from the state motto because we need good health to sustain ourselves as a people and a state. The foundation of the new health care proposal is a public-private insurance pool which would be opened to businesses that want to offer their employees high quality, affordable health plans. SustiNet is not designed to replace private health cover, but rather to stimulate competition.

Businesses that enroll in SustiNet would spend less than they do today to cover their employees. Those that cannot afford to cover their employees in the current market will have the option of joining SustiNet.  

SustiNet comes with shared responsibility for costs.  It requires the state to invest $950 million in 2014. This investment by the state would lead to a $1.7 billion in savings for households and businesses. And it would result in everyone having health coverage. It also would stimulate $800 million in new federal funds for Connecticut.

The bottom line is that every dollar that the state spends on SustiNet would return $2.60 in savings and new funds. Without SustiNet, health care costs will continue to rise faster than our wages, leaving more families and businesses unable to afford health care. The number of people with poor coverage will also continue to increase. The cost of not acting is too high.  That is already costing us all more money and compromising our health.

 
Can SustiNet be used as additional insurance for somebody who already has health insurance but has exclusion for a pre-existing condition?

SustiNet offers state residents the choice of a high-quality, comprehensive health care plan – with no exclusions for pre-existing conditions.  It is not designed as an add-on to other plans.  People with insurance that does not cover their pre-existing conditions would want to give serious consideration to SustiNet as a smart choice for comprehensive health care coverage.  Employers who value a healthy workforce would also want to consider choosing SustiNet for their employees.

Some conservative commentators level have said programs
like these allow private companies to opt out of providing insurance for their employees and thus reduce their bottom line. Does this program eventually relieve private industry of paying for employees’ health insurance?

SustiNet was developed by a team of experts led by the Urban Institute and MIT with input from business, labor, health care providers and clergy across Connecticut.  In designing the plan, the concern about employers dropping their insurance was considered from the start. SustiNet would allow employees, employers and government to share responsibility for keeping Connecticut’s people – and economy – healthy.

Incidentally, this strategy reflects the overwhelming message we got from the many business people and groups engaged in the proposal’s development.   

Under SustiNet, employers are encouraged to provide quality, affordable health care coverage to their employees.  Medium-sized and larger employers could choose not to do so and instead make shared-responsibility payments to help cover the costs of their employees’ SustiNet care. 

Once SustiNet is fully in place, employers would be able to choose to purchase SustiNet for their employees and reduce their costs, improve the health and productivity of their workforce, and deliver savings to members. 

Is SustiNet solely reliant on the state employees and retirees becoming part of the self-insured pool? Does SustiNet become the umbrella for state employee, state retiree, HUSKY and SAGA (state administered general assistance)?
These groups allow SustiNet’s public-private insurance pool to build a “critical mass” of members right away and give SustiNet the momentum for economic success.  Large insurance pools have greater bargaining power due to their sheer number of members and because they spread risk over a larger group of individuals.  SustiNet’s unique, expandable pool would grow to include not just state employees and retirees and HUSKY and SAGA members – but also insured people without affordable and/or adequate employer-sponsored insurance; sole proprietors and other self-employed people; and the employees of any employer – including municipalities, non-profits, and for-profit firms – who decides to join SustiNet for worker health coverage. 

Eventually, with the new choice of SustiNet, at least 98 percent of Connecticut would have the coverage it needs to be healthy, productive, and free from health insurance worries.  Repeated surveys show that the vast majority of voters in Connecticut favor health care coverage for everyone in the state.  SustiNet would help make that a reality.

Clinicians will play a central role in determining standards of care. Is there a danger that this will drive expenses up as they demand the absolute best care?

Quality of care is an important concern among clinicians. Physicians and other providers should be demanding the best care for their patients.  To ensure high-quality, efficient, and effective health care through SustiNet, health care provider advisory groups would play a role in setting guidelines for providers and hospitals.  SustiNet’s public-private governance board – composed of people from business and various other groups – would run the plan, and would have the final say over all elements of SustiNet. 

Do the clinicians also play a role in determining what is fair compensation for their work?

As we know, for many years low Medicaid reimbursement rates for physicians and hospitals have forced them to shift their costs to the private insurance of their patients who have it.  SustiNet’s reasonable payments to physicians and hospitals can prevent this cost-shifting and reduce overall costs in our health care system. SustiNet’s provider advisory groups would set “quality of care” guidelines and help create other cost-saving and quality-improving elements of SustiNet’s innovative health care delivery system.  As stated earlier, SustiNet’s public-private governance board would have the final say over all elements of SustiNet, including health care provider compensation.  And one of the charges of the board is to regularly report quality and cost outcomes to the public.