September 16, 2008
CONNECTICUT AUTHORITIES STUDYING HEALTH CARE COVERAGE ACCESSIBILITY AND AFFORDABILITY
By: Janet L. Kaminski Leduc, Senior Legislative Attorney
You asked for information on what the legislature is doing to make quality health insurance accessible to and affordable for Connecticut residents.
In 2007, the legislature created the HealthFirst Connecticut and the State-Wide Primary Care Access authorities to study this issue and report findings and recommendations to the legislature. The HealthFirst Connecticut Authority must report its recommendations, including strategies for increasing health care access, to the Public Health, Human Services, and Insurance committees by December 1, 2008. The State-Wide Primary Care Access Authority must report annually to the same committees on its progress in developing and implementing a universal primary care system. The first report was due by February 1, 2008; subsequent annual reports are due by January 1.
By law, the authorities' members must be familiar with the Institute of Medicine's (IOM) health care reform principles and be committed to making recommendations consistent with them. The IOM's principles for health care are:
3. affordable for individuals and families;
4. affordable and sustainable for society; and
5. enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient centered, and equitable.
HEALTHFIRST CONNECTICUT AUTHORITY
The HealthFirst Connecticut Authority must:
1. examine and evaluate different alternatives for providing Connecticut residents with quality, affordable, and sustainable health care, including a single payer health care system and employer-sponsored health plans;
2. recommend ways to contain the cost and improve the quality of health care, including health information technology, disease management, and other initiatives to coordinate and improve the quality of care for people with chronic diseases; and
3. recommend ways to finance quality, affordable health care coverage, including ways to (a) maximize federal health care subsidies and contributions from employers, employees, and individuals and (b) finance the state's share of such coverage.
The law authorized the legislative leaders and the governor to appoint 10 members, some of whom must represent specific interests, as shown in Table 1. The public health, social services, and insurance commissioners; the comptroller; and the health care advocate are ex-officio, nonvoting members.
The authority has been meeting since October 2007 and must report its recommendations, including recommended strategies for increasing health care access, by December 1, 2008, to the Public Health, Human Services, and Insurance committees. (See § 30 of PA 07-185 and § 67 of PA 07-2, June Spec. Sess.)
The authority's meeting agendas, minutes, presentations, and other information are available at http://cgalites/ph/HealthFirst/default.asp.
Table 1: HealthFirst Connecticut Appointments
(Number of Appointments)
● Health quality or patient safety advocate
● Person with information technology experience
Senate president pro tempore (2)
● Representative of businesses with fewer than 50 employees
● Person with community-based health experience
House speaker (2)
● Health care provider
● Representative of businesses with 50 or more employees
Senate majority leader (1)
● Labor representative
House majority leader (1)
● Consumer representative
Senate minority leader (1)
● Hospital representative
House minority leader (1)
● Insurance company representative
STATE-WIDE PRIMARY CARE ACCESS AUTHORITY
The State-Wide Primary Care Access Authority must:
1. determine what constitutes primary care services;
2. inventory the state's existing primary care infrastructure;
3. by December 31, 2008, develop a universal system, which maximizes federal financial participation in Medicaid and Medicare, to provide primary care services, including prescription drugs, to state residents; and
4. by July 1, 2010, develop a plan for implementing the system.
The inventory of the primary care infrastructure must include the (1) number of state primary care providers; (2) amount of money spent on public and private primary care services during the last fiscal year; and (3) number of public and private buildings or offices used primarily for primary care services, including hospitals, mental health facilities, dental offices, school-based health clinics, community-based health centers, and academic health centers.
A “primary care provider” is any physician, dentist, nurse, provider of services for the mentally ill or persons with mental retardation, or any one else providing primary medical, nursing, counseling, or other health care, substance abuse, or mental health service, including such services associated with, or under contract to, a health maintenance organization or medical services plan.
The authority must:
1. estimate the cost of fully implementing the universal primary care services system it develops;
2. identify any additional infrastructure or personnel needed to implement it;
3. determine the role of the state, private health insurance, and third parties in the system; and
4. identify funding sources.
The authority's plan for implementing the system must include (1) an implementation timetable, (2) benchmarks to assess the state's progress in implementing the system, and (3) ways to measure the system's effectiveness.
The 11-member authority is composed of:
1. the chairpersons of the HealthFirst Connecticut Authority (see above), who also serve as this authority's chairpersons;
2. the public health and social services commissioners;
3. the comptroller; and
4. members appointed by the (a) Connecticut (i) Primary Care Association, (ii) State Medical Society, (iii) Chapter of the American Academy of Pediatrics, (iv) Nurses Association, and (v) Association of School-Based Health Centers and (b) Weitzman Center for Innovation in Community Health and Primary Care (which is affiliated with Community Health Center, Inc.).
The authority has been meeting since October 2007 and must report annually to the Public Health, Insurance, and Human Services committees on its progress in developing and implementing the universal primary care system. The first report was due by February 1, 2008; subsequent annual reports are due by January 1. (See Section 31 of PA 07-185.)
The authority's meeting agendas, minutes, presentations, and other information are available at http://cgalites/ph/PrimaryCare/default.asp.