New Haven Independent

The governor, the legislature, and their competing advisory panels will face off to decide how to enact federal reform plans.

Their first decision — opt-out or stay in?

Different versions of health care reform have now passed committees in both houses of Congress, and, on Saturday night, the full House of Representatives.

The House version includes a federal health insurance program for the uninsured (known as the “public option”). A final version of health reform that includes a public option would probably also include an “opt-out” provision. If that happens, the ball bounces to state governments, which will have to decide whether to remain in the program.

Lawmakers will be looking to several sources for advice — and to justify their actions. At the top of the list of advice-givers are two ideologically opposed advisory boards formed this year amid Connecticut’s own health reform debate.

One, SustiNet, was created by the Democratic legislature and aims for universal health coverage.

The other, the Connecticut Health Care Advisory Board, was created by Republican Governor M. Jodi Rell to advocate a more modest alternative to SustiNet, which she tried to kill with a veto. (The legislature overrode her veto.)

Which panel gets to speak for Connecticut?

The answer to that question matters not just for the opt-out call, but for other decisions that will have to be made as Connecticut implements federal health care reform, too.

The federal plan will include new regulations on Medicare coverage, Medicare eligibility, and possible individual insurance mandates. There will be new rules for insurance companies and new rules about state monitoring of insurance companies. There will be new federal grants that states can apply for.

Lawmakers in Hartford will have to decide where and how to allocate resources as Connecticut responds to all of these changes.

In the view of the co-chairs of the SustiNet board, their panel is the one body empowered to weigh in on federal health care implementation.

In the view of the head of the governor’s Connecticut Health Care Advisory Board, both boards are legitimate, and two panels will only enrich the debate.

“Connecticut could be really up a creek if they don’t get this right,” warned Ellen Andrews, a health care consumer advocate who has been watching developments closely.

SustiNet’s 60 Days

When the Connecticut legislature passed the SustiNet health care bill in May, it was hailed as the beginning of a landmark movement to ensure that health care coverage extends to all Connecticut residents.

The bill established a nine-member board charged with coming up with a plan, by Jan. 1, 2011, for a statewide, affordable public health insurance plan called SustiNet.

Then in July, Gov. Rell vetoed the bill. In place of the Sustinet advisory board, she created her Connecticut Health Care Advisory Board. She ordered the 15-member panel to “prepare a set of proposed health care policies in response to federal health care reforms.” The board would consider policies that provide for health care coverage that is affordable and “sustainable for society.” Her board’s deadline is also Jan. 1, 2011.

Days later, the legislature voted to overturn Rell’s veto, and SustiNet moved forward. But Rell’s advisory board remained in effect.

The SustiNet board has now held four meetings, said co-chair Kevin Lembo, who is also the state’s health care advocate.

He said the SustiNet statute requires the board to report to the legislature with advice within 60 days of the passage of federal health care reform. The board will advise lawmakers on the best way to “synch up” with the federal plan, “to be hopefully first in line to be part of the state and federal solution,” Lembo said.

SustiNet will need to examine the federal plan and see where it falls short and where state plans will have to pick up the slack, Lembo said. For instance, SustiNet may place a greater emphasis on preventative care than the federal plan does. Or maybe the federal plan will target only the uninsured, and SustiNet will look at covering the underinsured.

“Say they don’t talk about mental health … or chronic disease management,” said State Comptroller Nancy Wyman, Lembo’s co-chair on the SustiNet board. SustiNet would try to find ways to “put that in to make a full package,” she said.

The panel will have to determine how to “interweave” state and federal plans, Wyman said. There will be federal funding available for health care initiatives, she said. SustiNet will be trying to “see what has to be done to be the first to get the money,” Wyman said.

SustiNet vs. Rell’s Board

Perhaps most importantly, SustiNet will advise lawmakers about whether or not to “opt out” of the federal public option plan. And so will Rell’s Health Care Advisory Board.

It’s still unclear which part of state government will be empowered to opt out, said Ellen Andrews. It might be state legislatures that choose, or it might be governors. “It’s not a decision that’s been made yet,” she said.

Andrews said that the National Governors Association has been pushing for governors to have the authority to opt out by executive order, which would allow Rell to reject the federal public option on her own.

“We’re afraid she’s going to say we don’t need this because we’ve got Charter Oak,” Andrews said, referring to a smaller-scale insurance plan Rell created for people who previously made a little too much money to qualify for the state HUSKY plan.

Whoever makes the decision — to opt out or not — will be looking to SustiNet or Rell’s advisory board to help them decide. The co-chairs of SustiNet said that they are in favor of the public option. The chair of Rell’s board said it is too soon to say.

Which panel has the authority?

Ours, said the SustiNet co-chairs.

“The group [Rell] put together was connected to her veto message of SustiNet,” said Lembo. That veto was overturned, which “makes her planning group redundant.”

“It doesn’t serve us well to have competing planning processes,” he said. “It would be really unfortunate for the governor’s group to go forward.”

“The law of Connecticut around this plan is embodied in the SustiNet board,” he said. “SustiNet will be the primary voice of response on federal action.”

A number of advocacy groups will weigh in on how to implement federal health care reform, Lembo said. He mentioned hospitals, medical societies, pharmaceutical companies, and other special interest groups. “I see the governor’s committee as being one of those,” he said.

Lembo said that SustiNet has invited members of the governor’s panel to join SustiNet as “ex officio” members. “They all showed up,” he said. “It’s been actually pretty constructive.”

“It would be better if we were doing it under one roof rather than two,” said SustiNet Co-Chair Wyman. “SustiNet should be the foundation.”

Wyman was also appointed to the governor’s board, but said that she doesn’t think that body even exists. “I sit on the governor’s health care advisory board. We’ve never met,” she said. “I have assumed we wouldn’t be meeting.”

Meeting 1 Planned

Rell’s advisory board is meeting, said board Chairperson Cristine Vogel, who is also the head of the Office of Health Care Access. The first meeting will be on Nov. 17.

The formation of the board has been delayed by the fact that the her office was recently folded into the Department of Public Health, Vogel said. The board is not fully staffed with its 15 members, since Democratic leaders in Hartford have declined to appoint members, she said.

Vogel argued that both boards will have authority to speak on the federal plan, but it’s too soon to worry about the fact that there are two boards.

“Everything right now is a hypothetical question,” she said. It could be much as two years before the health care reform plan comes to Hartford from Washington, she said.

More panels might mean more good ideas, Vogel said. “Having more recommendations out there … hopefully will allow us as a state to take some of those recommendations and get something done,” she said.

“You know the saying two heads are better than one?” she said. “Maybe two boards are better than one.”

Andrews, the head of the ten-year-old Connecticut Health Policy Project, disagreed with Vogel.

“It certainly doesn’t bode well,” she said about the presence of two boards rather than one.

Rell’s board should be disbanded, she said. “It was part of her veto, but the veto was overturned so I don’t think it has a place.”

The SustiNet board is “the law of the land,” Andrews said.

If the federal health reform bill doesn’t state that both the legislature and the governor have to work together to decide to opt-out, things could get messy, Andrews said.

“Hopefully it will be both,” she said. “Then they’ll have to play nicely.”