Connecticut's SustINet Health Care Law:
Moving into Phase II
In 2009, the Connecticut legislature passed SustiNet, a state-specific health care reform law that aims to spend our health care dollars more wisely, promote better health, slow the cost of health care and provide more choice in health care plans to state residents.
Designing the SustiNet Health Care Plan
Phase I of the law established the SustiNet Health Partnership Board of Directors. The 11-member board worked for 16 months to develop recommendations for action in 2011. They were aided by nearly 200 Connecticut volunteer experts from all walks of life, who served on five committees and three task forces that advised the board on health care issues ranging from designing a state health plan, SustiNet, to promoting prevention and effective management of chronic illness.
With the support of national health care experts, the board conducted 20 meetings, two public briefings, one legislative briefing and numerous advisory committee and task force meetings – all of which were open to the public. On January 7, 2011 the board transmitted a full report of recommendations to the Connecticut legislature and governor.
Ready for Action in 2011
The board worked to develop a report that took into account the 2010 federal Affordable Care Act. It addresses ways the state can maximize new federal health care dollars to implement effective ways to deliver care and improve health outcomes, as well as expand coverage to more people. The report outlines ways in which the state can spend its health care dollars more wisely to save money and slow costs over time. Finally, the report recommends that Connecticut eventually open a new, state health plan called SustiNet to be offered to individuals and businesses as an option.
Key features of the SustiNet Health Partnership Board of Directors proposal:
SustiNet will spend our state health care dollars more wisely
- Streamline overhead costs and build the bargaining power of larger numbers by pulling together the pools of people the state already insures: state employees, retirees and their dependents and the state's safety net programs – HUSKY, Medicaid and SAGA. Beginning in 2011, all these pools will be under one administrative umbrella, the SustiNet Health Plan.
- The SustiNet Health Plan will leverage its bargaining power to work with doctors, hospitals and other health care providers that seek to provide care to people in the plan that focuses on best medical practices and achieving better health outcomes, which help control costs over time.
SustiNet uses a phased-in approach to enrollment
- SustiNet starts by bringing the people already insured by the state into the health plan: state employees, retirees and their dependents, and HUSKY, Medicaid and SAGA. They will keep their benefits as defined by law or collective bargaining.
- The new SustiNet Health Plan will offer a comprehensive health plan, including dental care and parity of coverage for physical and mental health conditions. It will offer a choice of coverage plans and out-of-pocket costs. It will be offered as an option to individuals and businesses, but is not a mandated plan.
- In 2011, or as soon as feasible, municipalities can offer SustiNet to their employees.
- As soon as feasible, offer SustiNet to small businesses and non-profits.
- In 2014, offer SustiNet as an option to all individuals and businesses, either through the new Health Insurance Exchange (the federal Affordable Care Act requires consumer-friendly exchanges to be up and running by 2014), or through other channels, such as brokers and agents.
- The SustiNet Board also recommends expanding eligibility to the state's HUSKY program. If funding can be identified prior to 2014, adults without children with incomes up to 185 percent of the federal poverty level can enroll in SustiNet via HUSKY.
- In 2014, HUSKY should be expanded to include adults without children with incomes up to 200 percent of the federal poverty level by maximizing federal funds available through the Affordable Care Act.
SustiNet invests in best health care practices:
- Uses its leverage to encourage and reward health care practices that invest in primary care, prevention, coordination and better long-term health outcomes, which will slow the growth of health costs over time.
- Coordinates care between an individual's primary health care provider and specialists, particularly people with chronic conditions such as diabetes, asthma or heart disease.
- Encourages investment in technology such as electronic medical records that reduce medical errors and duplication of services.
- Emphasizes making sure each individual has a primary care provider that focuses on prevention of illness and overall good health.
- Reforms incentives and payments to health care providers and rewards them for better health outcomes, prevention and coordinated care, as well as reduction of racial and ethnic disparities of care.
SustNet establishes a SustiNet Authority
- The quasi-public authority will have oversight over the SustiNet Health Plan.
- Experts in the areas needed for oversight of the health plan will comprise the authority.
- It will have two voting consumer members, as well as a Consumer Advisory Committee.
- It will act as an advisor to the legislature on matters that control health care costs and improve health.
- It will be bound by the highest legal standards of ethics, accountability and transparency.
You can read the full SustiNet Board report to the legislature.
You can also read the 2011 Sustinet proposed law and follow its progress online.
The Connecticut legislature and governor must act in 2011 to put SustiNet into Phase II of implementation. Sign up for CT Parent Power's Healthcare4every1 team to get the latest news.
