What Does It Take To Get A ‘Public Option’ Health Program Passed? | Connecticut Public Radio
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What Does It Take To Get A ‘Public Option’ Health Program Passed?

Jun 16, 2019

Democratic legislators and government officials stood with a small crowd of supporters at the Legislative Office Building in March to announce that it was time that Connecticut created a public option health insurance program. 

“It is going to be a lot of work, it’s going to be a lot of hard conversations,” said state Comptroller Kevin Lembo, adding, “if we get this right, we will be the envy of the nation.”

But the state fell short of that promise when just three months later, the proposal was dead.

Even with support from Gov. Ned Lamont and a Democratic majority in the General Assembly, lawmakers pulled the plan days before the end of the legislative session, citing a lack of time and pushback from the insurance industry, which former state Comptroller Bill Curry said was a big mistake.

“We keep failing to stand up to these large, powerful institutions and just say no,” he said.

There’s been many attempts at major health care reform both in Connecticut and at the federal level, and aside from some landmark programs like Medicare, Medicaid and the Affordable Care Act, most have failed. Now supporters of these plans are asking: whose fault is it?

At least in Connecticut, Curry and other critics said influence from the private health insurance industry has stopped many of these public option plans in their tracks. The state is home to two of the nation’s largest carriers: Aetna and Cigna.

“This is about the role of money in our democracy,” Curry said. “This is about the ability of powerful, vested interests to mortgage the government and the entire society to the past.”

In 1991, Curry proposed one of the earliest state-sponsored, public option proposals in the country. It didn’t pass, but it’s become a model for several states now seeking this type of health care reform to make insurance cheaper for small businesses and individual employers.

Nearly 30 years later, Curry maintains that health insurers then, too, played a big part in stopping a public option from happening.

But large health insurers are pushing back against this narrative. The Connecticut Association of Health Care Plans, which represents state insurers and other health providers, testified that this year’s proposal — which went through multiple revisions — would destabilize the existing insurance markets and potentially drive up health care costs, not bring them down.

The last version of the Connecticut proposal stated that the government would run and partly subsidize a health insurance program that would offer, through private insurers, cheaper plans on the state’s health exchange. Opponents of the bill said these plans would unfairly compete with the ones private insurers already offer.

“The fear, I think, on the side of industry is that the government is going to cut some sort of deal that really, they feel, would undercut their private sector goals,” said Rosemarie Day, a health care reform consultant and owner of Day Health Strategies in Massachusetts.

The proposal started to unravel further after Lembo told The Hartford Courant that Cigna, a major private employer, threatened to leave the state if it happened. But spokesman Brian Henry said no one at the company made that threat, or insinuated anything like it.

“Now what we have said, and we’ve been very clear and consistent about, is that the only option that this proposal gave to the public is to pay more to get less from the health care system,” Henry said. “The option just doesn’t work for the public, or the state or really for the private sector either.”

Some legislative officials and advocates, as well as private citizens, have been critical of the perceived power that health insurers have in policy making as companies continue to grow profits and overall health care costs rise for consumers.

But Henry said bringing down health care costs is a priority for Cigna, and that insurers deserve to have a voice in health reform policy discussions. He pointed out that health care delivery often involves public-private partnerships to work.

“There’s a lot we bring to the table, so on behalf of our employees and also given the fact that we have a deep expertise, that’s worth listening to,” he said. “It may not be that everyone agrees with it, but we think that if you’re going to have an informed conversation, hearing from all stakeholders is important.”

Across the country, Washington state was able to do what Connecticut could not. Last month, it passed a version of a public option health insurance program, considered one of the first to do so.

Democratic Rep. Eileen Cody, one of the lawmakers leading those efforts, said several health insurers and providers are on board, but it wasn’t always like that.

Cody says health insurers and providers were against the plan at the beginning. But as time went on, “we negotiated with them just to see where we thought we could go . . . I won’t say they were ever happy, but that they were agreeable to it.”

That was important, because Washington’s public option plans will be offered through private insurance carriers on the state’s exchange. Cody said they don't yet know for sure which carriers will officially sign on to offer the plans. The program is currently being built.

Day said government and the private sector are very intertwined when it comes to health care delivery — most of the country’s major health insurance programs involve private businesses and companies.

But there’s no doubt that health care costs, including the prices for health services and prescriptions, as well as insurance deductibles and premiums, leave patients and their families struggling.

“I don’t think we want to give up on our private sector solutions — there’s a lot of good things there, innovation, etcetera,” Day said. “But there can also be excessive profits that take consumers for granted and that the payers will somehow keep paying. That’s where I think there may need to be some guardrails.”

Connecticut Democrats say they intend to try again for a public option program in the next legislative session.