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Public options — the right Rx for Connecticut

Recently, a patient of mine nearly died when he allowed his blood count to get too low. The patient suffers from a serious, chronic illness that causes slow blood loss. He didn’t have insurance, so he avoided medical care until he felt so weak that he would go for a transfusion. This time, he waited too long. His hemoglobin fell to 4.7 — one-third of normal levels — which could have been fatal. Fortunately, he survived, but his brush with death is a story that many Americans who also lack health insurance know all too well.

While the Affordable Care Act — aka Obamacare — dramatically reduced the number of Americans who lack health insurance, yet it still left millions uninsured. In Connecticut, over 200,000 residents were uninsured in 2019. That number is undoubtedly higher this year as many state residents have lost their jobs in the pandemic and, with those jobs, their health insurance. In September, more than 147,000 Connecticut residents were unemployed — more than double the number of unemployed in March when COVID-19 cases began to spike.

A lack of health insurance leads to a lack of health care, which in turns leads to increased death and disability. This burden falls disproportionately on working families who are earning too much to be on Medicaid or to receive subsidies through the ACA for insurance through the state’s health care exchange. Many of my uninsured patients at the Community Health Center in New London work for small businesses or nonprofit organizations. For them, help might be on the way in the form of public options for Connecticut.

Simply put, public options gives consumers a choice between a government-sponsored health insurance plan and commercial plans. This is the way Medicare works now. Seniors can choose between the traditional government-sponsored Medicare or commercial plans called Medicare Advantage.

Here in Connecticut, legislative leaders and the state comptroller are proposing a public option that would allow workers in small businesses, nonprofit organizations, and labor unions with Taft-Hartley trusts to join a plan built off the State Employee Health Plan, which enjoys a well-deserved reputation for quality and efficiency.

Clearly, being able to obtain health insurance through the State Employee Health Plan would be a boon to those who currently lack insurance, but it also has benefits for the state as a whole by putting the brakes on rising health care costs. While health care was once quaintly described as a “cottage industry” of small medical practices and independent community hospitals, it has evolved into a highly concentrated industry with just two mammoth health systems in the state that wield near monopoly-like power, namely the Yale-New Haven Health System and Hartford Healthcare.

Enrolling thousands of beneficiaries to a new plan run by the State Employee Health Plan increases the bargaining power of the state as a counterweight to the behemoth health providers. Constraining the prices charged for the state plan will have a spill-over benefit to other plans that will demand similar prices for the rest of us. As Connecticut pulls in the reins on health care costs, it becomes a more attractive place for business investment and a more affordable place for all of us to live in.

The public option is not a panacea. It won’t achieve universal health insurance coverage. It won’t eliminate racial disparities in health overnight. But it is one move on the chess board of health care that puts us in a better position to win the game in the long run. Other public options such as expanding Husky coverage to its previous eligibility levels of 201 percent of poverty, including immigrants in Husky, and providing state subsidies in addition to ACA subsidies for private insurance for individuals can bring us even closer to the goal of affordable, high-quality health care for everyone.

In this doctor’s opinion, public options are the right prescription for the people of Connecticut.

Dr. Stephen R. Smith is a family physician who practices at the Community Health Center of New London. He is a New London resident and former city councilor and professor emeritus of family medicine at the Warren Alpert Medical School of Brown University.

 

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