Can Assembly get health care deal done?
There are only three days left to the regular session of the General Assembly. Entering the weekend, lawmakers and the governor had yet to agree on a comprehensive plan to make health insurance more affordable and available. The need is particularly great for self-insured middle-income residents and for small businesses that would like to provide employee coverage but can’t afford it.
This is particularly regrettable because everyone agrees on the need to do something — progressive Democrats, the minority Republican caucus, centrist Democrats, and Gov. Ned Lamont. But, as of the last full week of the session, they had failed to agree on what.
The preferred approach of the progressives — providing a public option that could compete with private insurance and drive down costs — ran out of steam because of a lack of support among party moderates and the opposition of Lamont. The governor feared that if costs ran high in providing a public option, the burden would fall on taxpayers to cover the gap. Lamont also considered the rules gamed in favor of the public option over the private insurance industry, a major employer in the state.
An alternative proposal, with support from the governor, the Republican minority, and many members of the Democratic caucus, emphasizes the use of “reinsurance” to lower premiums. But, again, agreement on the details is lacking.
What is interesting about the Republican approach is that it utilizes some of the structure of the Affordable Care Act, aka Obamacare, which from the start has been attacked by Republicans in Washington.
Reinsurance works by helping cover high-cost claims that may be incurred by insurance companies. It guarantees that if the cost of paying for claims exceeds a certain amount, insurers will receive government assistance, rather than being forced to recoup losses through higher premiums. Some estimates predict preinsurance could drop the cost of premiums by up to 30%.
When the Affordable Care Act was established, it included a federal reinsurance program. But Congress let the reinsurance component expire in 2016, “leaving the insurance market unstable and resulting in skyrocketing premiums,” states a policy paper put out by Connecticut Republicans in the legislature. It doesn't mention Republican opposition contributed to end of the federal reinsurance program.
“However, the Affordable Care Act did provide an opportunity for states to establish their own programs,” the GOP policy statement points out. And Connecticut Republican lawmakers want to take advantage of it to not only lower premiums through reinsurance, but attract more federal funds.
One big disagreement is how to pay for the reinsurance supplements. Lamont has floated the idea of a $50 million assessment on health insurance companies. Republicans make a persuasive case that the approach would be counterproductive to the goal of lowering premiums. They want to find the money elsewhere in the budget, but don’t exactly say where.
Given federal pandemic aid and a record surplus, the Lamont administration should be able to find the money without the assessment.
Another sticking point is how to control prescription drug costs. On this issue, it is the governor who is more practical in calling for price caps. Republicans want to import cheaper drugs from Canada where the prices are effectively, you guessed it — capped!
There is broad support in the Democratic caucus for expanding income eligibility for Medicaid coverage for children and parents, but again a lack of agreement on how to pay for it.
Improving access to health care is a moral issue, but also an economic one. Health insurance insecurity can discourage people from seeking new job opportunities or opening or expanding a business. Lawmakers and the governor need to find a path to get this done.
Paul Choiniere is the editorial page editor.